Longevity Medical LLC

Primary specialty

Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0808X

License

APN14184 Issued in TN

Legal business name

LONGEVITY MEDICAL LLC

Practice address

1355 B Lynnfield Rd
Ste 205
Memphis, TN 38119-5801

Phone

(901) 440-6045

Fax

(901) 459-3373

NPI assigned

Jan 23, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Vickie D Long, DNP,FNP-BC,PMHNP-BC

Title

Owner

Phone

(901) 440-6045

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1327276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615420800000",
    "number": "1467723486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4355",
            "city": "CORDOVA",
            "state": "TN",
            "postal_code": "380884355",
            "telephone_number": "901-440-6045",
            "fax_number": "901-459-3373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1355 B LYNNFIELD RD",
            "address_2": "STE 205",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381195801",
            "telephone_number": "901-440-6045",
            "fax_number": "901-459-3373"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1076 Chambliss Rd",
            "address_purpose": "LOCATION",
            "city": "Memphis",
            "state": "TN",
            "postal_code": "381166381",
            "country_code": "US",
            "telephone_number": "901-396-8470",
            "fax_number": "901-398-0271",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1250 Farrow Rd",
            "address_purpose": "LOCATION",
            "city": "Memphis",
            "state": "TN",
            "postal_code": "381167116",
            "country_code": "US",
            "telephone_number": "901-332-7290",
            "fax_number": "901-332-4176",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1669 Stable Run Dr",
            "address_purpose": "LOCATION",
            "city": "Cordova",
            "state": "TN",
            "postal_code": "380167624",
            "country_code": "US",
            "telephone_number": "901-736-6722",
            "fax_number": "888-873-5467",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9684 Goodman Rd",
            "address_purpose": "LOCATION",
            "city": "Olive Branch",
            "state": "MS",
            "postal_code": "386541726",
            "country_code": "US",
            "telephone_number": "662-895-7616",
            "fax_number": "662-895-3501",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LONGEVITY MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-23",
        "last_updated": "2021-03-11",
        "certification_date": "2020-08-31",
        "status": "A",
        "authorized_official_last_name": "LONG",
        "authorized_official_first_name": "VICKIE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "901-440-6045",
        "authorized_official_credential": "DNP,FNP-BC,PMHNP-BC"
    },
    "taxonomies": [
        {
            "code": "163WG0600X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Gerontology",
            "state": "TN",
            "license": "APN14184",
            "primary": false
        },
        {
            "code": "163WP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "TN",
            "license": "APN14184",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1527059",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jody G Long, LCSW
• Leslie Long, APRN
• Russell K Long
• Thomas E Long, M.D.
• Vakendall V Long, LCSW
• Mindy K Longjohn, MD
• Longmire Counseling Services, LLC
• Longmire Health Group
• James Leroy Longmire II, FNP-BC
• Peter Longoria, LPC-MHSP (TEMP)

• Psychiatric/Mental Health Registered Nurse in Memphis, TN
• Providers in Memphis, TN by specialty
• Psychiatric/Mental Health Registered Nurse in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.